As climate change continues to cause adverse health effects, researchers and health professionals are developing solutions to help communities adapt to a changing climate and extreme weather events. But a key question remains: how do local governments, health organizations, and health professionals implement these adapted health practices so they reach everyone in a community?
From knowing to doing
Interventions are health treatments that we know work, but often don’t reach the people who need them and therefore don’t produce the expected health benefits.
In other words, there is a “gap between what we know and what we do,” Jeremy Hess, MD, MPH explains.
Hess serves as PI for a new implementation science research initiative. He is a professor of Environmental and Occupational Health Sciences, Global Health, and Emergency Medicine at the University of Washington, and director of the UW Center for Health and the Global Environment (CHanGE).
Implementation and Evaluation (I&E) Science examines why this gap exists and how to close it. It evaluates how effectively interventions, theories, frameworks, and models can be delivered across different real-world settings.
One of the key concepts I&E researchers consider is the do-know gap: the proportion of people who have access to an intervention relative to those who still need it, often measured by the time it takes for an intervention to reach a given population.
Implementation research helps researchers, practitioners, policymakers, and other stakeholders think more broadly about what drives implementation effectiveness and what resources it takes to close the do-know gap.
“When talking about climate and health, for instance, we see it in the limited coverage of heat early warning systems and action plans,” Hess notes.
The science behind implementing science
While an intervention may directly impact health outcomes, it’s important to distinguish that implementation outcomes and health outcomes are not the same thing.
“Implementation outcomes measure how well an intervention is put to use, while health outcomes measure whether people’s health actually improves as a result of these interventions,” shares Kenneth Sherr, PhD, MPH, professor in the UW Department of Global Health. His research focuses on developing and testing implementation strategies to support integration into primary health care systems and improve the quality and coverage of evidence-based health interventions.
There are eight implementation outcomes that are commonly referenced:
- Acceptability: How satisfied and comfortable stakeholders are with the intervention.
- Adoption: The decision by an organization or provider to take up and begin using the intervention.
- Appropriateness: How well the intervention fits the setting or problem it's meant to address.
- Feasibility: How realistically the intervention can be carried out given available resources and possible constraints.
- Fidelity: How closely the intervention is delivered to its original design.
- Implementation cost: The financial resources needed to fund the intervention.
- Penetration: How thoroughly the intervention reaches its intended population within a service setting.
- Sustainability: Whether the intervention continues to run and/or becomes part of standard practice over time.
Achieving even one of these outcomes can be difficult. What implementation success requires doesn't always align with what stakeholders are willing to accept, making these trade-offs difficult for I&E researchers to navigate.
“It can be particularly difficult to measure fidelity, for instance, because sometimes it is appropriate to change the implementation protocol to accommodate different circumstances,” Hess says. “In such cases, deviation from the original protocol may be necessary to maintain effectiveness, but fidelity would be seen as low.”
This is why implementation research is so essential. While implementation programs and strategies may already be in place, they can always be improved to achieve the desired implementation outcomes and, in turn, positive health outcomes for impacted communities.
“Understanding what these determinants of implementation are can then guide how to better target strategies to improve implementation outcomes and maximize the potential impact of interventions to improve patient and population health,” Sherr says.
CHanGE is turning implementation into action
So how will implementation research and strategies be utilized to address climate-related health issues in the coming years?
Sherr believes that as research continues, climate health programs will develop implementation strategies that better fit environmental health concerns.
“The application of implementation science methods to the field of environmental health is relatively nascent. I think that – as the field of environmental health and climate health programs become more exposed to implementation science – the future will bring more and more examples of how to apply these methods in a way that is appropriate for the field,” says Sherr.
The REACH Center is working to close that gap now.
The REACH Center is an interdisciplinary team at the UW with a mission to use research, community voices, and implementation strategies to develop, implement, and evaluate health interventions to protect public health and safety in the face of extreme weather events and environmental conditions. The center is funded by an exploratory research grant from the National Institutes of Health (NIH) and partners with local health organizations and institutions to find real-world applications for researched healthcare practices.
The Center is organized into four cores: administrative (financial management and coordination), research (leading intervention studies), community engagement (shaping activities and implementation with community input), and implementation and evaluation, which runs a fellowship program training interdisciplinary teams to evaluate and implement climate and health interventions. Together, this team is advancing implementation strategies and helping ensure public health interventions reach the people who need them most.
Hess sees that training as a critical step to a lasting impact.
“I am prioritizing training in implementation science for myself and my trainees, students, and colleagues so we can all benefit from the insights it can provide,” he says.
To learn more about implementation science and how it’s being used to improve community health, visit What is Implementation Science?
- Reach Center
